Toll样受体4信号通路分子与风湿性心脏病患者心功能相关性分析

蒋书云; 李萌; 乔娜; 江丽青; 段维勋; 王晓武

doi:10.12125/j.chj.202010043

Toll样受体4信号通路分子与风湿性心脏病患者心功能相关性分析

Correlation analysis of Toll-like receptor 4 signaling pathway molecules and cardiac functions in patients with rheumatic heart disease

摘要

摘要:
目的探究Toll样受体4(TLR-4)信号通路分子与风湿性心脏病患者心功能的相关性。
方法选取2018年12月~2020年5月空军军医大学第一附属医院心血管外科收治的风湿性心脏病患者200例作为风心病组，根据美国纽约心脏病协会(NYHA)心功能分级标准，将其分为NYHA Ⅱ级47例，NYHA Ⅲ级96例，NYHA Ⅳ级57例。另选取50例于我院进行常规体检的心功能正常者作为对照组。比较两组受试者及不同心功能分级风湿性心脏病患者外周血中TLR-4、核因子κB(NF-κB)和髓样分化因子（MyD88）蛋白水平及左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)，并分析风湿性心脏病患者TLR-4、NF-κB和MyD88蛋白水平与以上心功能指标的相关性。
结果与对照组相比较，风心病组TLR-4、NF-κB、MyD88以及LVEDD水平均明显偏高，而LVEF则明显偏低(P<0.01)。NYHA Ⅳ级患者TLR-4、NF-κB、MyD88以及LVEDD水平均显著高于NYHA Ⅲ级、NYHA Ⅱ级患者，且NYHA Ⅲ级亦显著高于NYHA Ⅱ级(P<0.05或P<0.01)；NYHA Ⅳ级患者LVEF水平均显著低于NYHA Ⅲ级、NYHA Ⅱ级患者，且NYHA Ⅲ级亦显著低于NYHA Ⅱ级(P<0.05)。Pearson相关分析发现，风湿性心脏病患者外周血中TLR-4、NF-κB、MyD88水平与LVEF水平均呈显著负相关(r=−0.452、−0.321、−0.346，P<0.01)；TLR-4、NF-κB、MyD88水平与LVEDD水平均呈显著正相关(r=0.502、0.306、0.491，P<0.01)。
结论在风湿性心脏病患者外周血中TLR-4、NF-κB、MyD88的表达和病情严重程度间存在密切关系，可以作为评估该疾病患者心功能及预后的重要指标之一。

Abstract:
AIM To explore the correlation between Toll-like receptor 4 (TLR-4) signaling pathway molecules and cardiac functions in patients with rheumatic heart disease.
METHODS Selected for study group were 200 patients with rheumatic heart disease admitted to the Department of Cardiovascular Surgery in our hospital from December 2018 to May 2020. According to the New York Heart Association (NYHA) cardiac function grading standard, the patients were divided into NYHA Ⅱ (47 cases), NYHA Ⅲ (96 cases) and NYHA Ⅳ (57 cases). Another 100 patients with normal heart functions who underwent routine physical examination in our hospital were selected as control group. Levels of TLR-4, nuclear factor kappa B (NF-κB) and myeloid differentiation factor (MyD88) protein and left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were compared between the groups and the correlation between TLR-4, NF-κB and MyD88 protein levels were analyzed in patients with rheumatic heart disease.
RESULTS Compared with those in control group, the levels of TLR-4, NF-κB, MyD88 and LVEDD in study group were significantly higher, while LVEDD was significantly lower (P<0.01). The levels of TLR-4, NF-κB, MyD88 and LVEDD in NYHA Ⅳ patients were significantly higher than those in NYHA Ⅲ and NYHA Ⅱ patients, and the levels in NYHA Ⅲ patients were also significantly higher than those in NYHA Ⅱ patients (P<0.05). The LVEF level in NYHA Ⅳ patients were significantly lower than those in NYHA Ⅲ patients and NYHA Ⅱ patients, and the LVEF level in NYHA Ⅲ patients was also significantly lower than that in NYHA Ⅱ patients (P<0.05). Pearson test found that the levels of TLR-4, NF-κB and MyD88 levels in the peripheral blood of patients with rheumatic heart disease were significantly negatively correlated with the LVEF levels (r=−0.452, −0.321, −0.346, P<0.01), but they were significantly positively correlated with LVEDD levels (r= 0.502, 0.306, 0.491, P<0.01).
CONCLUSION The expressions of TLR-4, NF-κB and MyD88 in the peripheral blood of patients with rheumatic heart disease are closely related to the severity of the disease, which can be used as one of the important indicators for evaluating the cardiac functions and prognosis of patients with this disease.

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